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Medical Forum / General / Vision / December 2005Should I accpt this vision?
1-1/2 weeks ago I had a Tecnis IOL implanted in my right eye, due to a very mature cataract. (Only 50, but had been hyperopic, had Staar ICL implanted, ended up with cataracts both eyes). The left eye was converted to IOL a couple years ago, and is under corrected by about 1.1 diopter (I need drugstore readers) and also has a mild astigmatism. Vision flaws in that eye are annoying, but tolerable. When I lost vision in the right eye I waited for slightly more than year before I got it treated, while I thought about the advancing state of the art ... my point is, I'm not neurotically picky about my vision. The outcome for the right eye is certainly an enormous improvement, but I wonder if anything should be done about some issues: 1. The lens is the wrong power for distance - it is focused at a bit under arm's length. The right eye is my dominant eye, so my distance vision is very blurred (touch for driving, nature viewing and such ... it's blurred enough that I see double at infinity). The doc warned me this could happen, because the cataract and ICL interfered with making a precise axial measurement; so he used the measurement taken by my original ophthalmologist 5 years ago. 2. The two eyes are focused at different distances. I had monovision contacts for couple years and they were fine, (I also had accommodation then) but I am having a perceptible lag in switching between eyes as I gaze at different things. Occasionally it's briefly dizzying. 3. There is a distracting dark shadow crescent on the outer edge of my field of vision, at fixed angle off-axis from gaze ... maybe 50 or 60 degrees. I try to ignore it, but it changes the brightness of peripheral objects as I redirect my gaze and they fall in or out of that zone, so that edge of vision sort of "flickers" all the time. It makes me want to clean out the corner of my eye all the time ... I am not getting used to this. 4. a point light source off-axis maybe 45deg causes a bright arc of light to appear; the center of the arc is diametrically across the center of vision from the light. That is, a light above centerline causes an arch below. I would guess it's light refracting at the boundary of the optic zone of the lens? The visibility of the arc depends on the background lighting and intensity of the light; mostly it's ignorable or minor. So I wonder if I should expect to get used to it all, and plan to balance my eyes with spectacles or contacts; or, if the new lens needs repositioning somehow (note that the image I see is good - not warped as it would be through a tilted lens, nor showing any effect that looks like astigmatism to me). And if the lens needs repositioning, is it better to have it done ASAP, or let the eye settle down after one surgical shock before enduring another? Thanks for any advice on how, and how strongly, to present all this to my doc next week ... Wayne Regarding #3 & 4: These symptoms sound like 2 of the 5 common dysphotopsias known to occur with IOLs, ssuming the lens is in fact centered. These are optic problems due to nature of IOLs. The dark shadow crescent was something I didn't know about until JacK Holliday (one of the IOL optics gurus) presented a talk about IOL dysphotopsias. I don't believe they understand the source of the dark crescent. Bright crescents, on the other hand, are light bouncing of the polsihed internal edge of the lens usually. Recentration, if needed, is best done early before the capsule contracts and the lens haptics get bound down. In the early stage repositioning is easy, but still re-opens the risk of infection. On 12/16/05 9:05 PM, in article 43a39c7d$0$95973$742ec2ed@news.sonic.net, > 1-1/2 weeks ago I had a Tecnis IOL implanted in my right eye, due to a > very mature cataract. (Only 50, but had been hyperopic, had Staar ICL [quoted text clipped - 51 lines] > > Wayne > > The dark shadow crescent was something I didn't know about until JacK > Holliday (one of the IOL optics gurus) presented a talk about IOL > dysphotopsias. I don't believe they understand the source of the dark > crescent. I think they are referring to them as "negative dysphotopsia" which I think is incorrect. Having experienced them myself, the shadows are more like "positive" scotomas because you can "see" or visualize the crescents readily. Anyway, mine never were a big problem and now, 11 months post op, I can only visualize them if I purposely and forcefully cross my eyes. I think it's the medial recti pulling on the side of the eyeball, translating some force to the ciliary body/lens capsule structures, and indirectly to the extreme nasal peripheral retina. w.stacy, o.d. >> >> The dark shadow crescent was something I didn't know about until JacK [quoted text clipped - 4 lines] > I think they are referring to them as "negative dysphotopsia" which I > think is incorrect. I just visited my ophthalmologist for the 2-week followup and he refers to the effect as "temporal crescent" > Having experienced them myself, the shadows are > more like "positive" scotomas because you can "see" or visualize the > crescents readily. Anyway, mine never were a big problem and now, 11 > months post op, I can only visualize them if I purposely and forcefully > cross my eyes. My doc says it is common, and I should expect to accommodate. > I think it's the medial recti pulling on the side of the > eyeball, translating some force to the ciliary body/lens capsule > structures, and indirectly to the extreme nasal peripheral retina. He didn't offer an explanation, just said it was "due to the type of lens" (a Tecnis) Wayne Your post is a bit confusing, but I'll try: > 1-1/2 weeks ago I had a Tecnis IOL implanted in my right eye, due to a > very mature cataract. (Only 50, but had been hyperopic, had Staar ICL [quoted text clipped - 6 lines] > before I got it treated, while I thought about the advancing state of > the art ... my point is, I'm not neurotically picky about my vision. OK by this I'm going to guess that the Left eye refracts hyperopic. It would be easier if you posted the Rx. Do the dimestore glasses help at far, or just near, or what? > The outcome for the right eye is certainly an enormous improvement, but > I wonder if anything should be done about some issues: [quoted text clipped - 6 lines] > precise axial measurement; so he used the measurement taken by my > original ophthalmologist 5 years ago. OK I'm assuming this is without any glasses. At least part of the problem is coming from the left eye, unless the above is with that eye covered up. > 2. The two eyes are focused at different distances. I had monovision > contacts for couple years and they were fine, (I also had accommodation > then) but I am having a perceptible lag in switching between eyes as I > gaze at different things. Occasionally it's briefly dizzying. Right, it seems that you are now antimetropic; that is the right eye is hyperopic and the left myopic. > 3. There is a distracting dark shadow crescent on the outer edge of my > field of vision, at fixed angle off-axis from gaze ... maybe 50 or 60 [quoted text clipped - 3 lines] > clean out the corner of my eye all the time ... I am not getting used to > this. Assuming this is only with the new Right lens, it's a fairly common phenomenon called dysphotopsia. It may go away completely, or you may learn to ignore it. Time will tell > 4. a point light source off-axis maybe 45deg causes a bright arc of > light to appear; the center of the arc is diametrically across the [quoted text clipped - 3 lines] > depends on the background lighting and intensity of the light; mostly > it's ignorable or minor. You are right, and this one is called photopsia due to the IOL edge. It too should resolve with time. > So I wonder if I should expect to get used to it all, and plan to > balance my eyes with spectacles or contacts; or, if the new lens needs [quoted text clipped - 3 lines] > better to have it done ASAP, or let the eye settle down after one > surgical shock before enduring another? Assuming the IOLs are postitioned correctly, you may want to have it explanted with a weaker lens to give you better distance vision. However, this will eliminate the one benefit you now have: being able to read without glasses. It would be really good if the left eye could also be explanted, but it's been too long to be a simple procedure. If you go for explanting the new lens, do it sooner, not later, as it's easier before the scarring sets in and tightens it up. Alternatively, just get some good glasses prescribed and you'll do just fine. w.stacy, o.d. OK, I will respond also, unfortunately, not as tactfully. There is stuff that happens as a result of any eye surgery. It sucks, but so does the crappy vision you had previously, hence your desire to fix it. The thing is, you have only had it recently, you have to wait for things to settle and adaptation to occur. How fast does this happen? Well, that depends on you. Give it time, be aware of the problems, but learn to accept them. Further surgery is risky and while it can be performed, it is best left until all other avanues have been explored. Cheers, sorry I can't be of more help. dr grant I agree with Grant. Cateracts gives crappy vision. Removing them almost always gives much better vision. Even the anti-lasik guys believe in cateract surgury. Some say if your vision falls below the 20/40 limit for driving, go ahead and get those removed, others say wait till your legally blind(worse than 20/200) from cateracts then you have nothing to lose. > Your post is a bit confusing, but I'll try: And I appreciate your making that effort! >> 1-1/2 weeks ago I had a Tecnis IOL implanted in my right eye, due to a >> very mature cataract. (Only 50, but had been hyperopic, had Staar ICL [quoted text clipped - 11 lines] > would be easier if you posted the Rx. Do the dimestore glasses help at > far, or just near, or what? I don't have the Rx - I ought to, but don't. I wear +2.5 to +3 readers to read with the left eye, and +1 readers to see at far with the left eye. With the +1, the left-eye image is still a little blurry; my memory from a long-ago Rx was that th left eye had mild astigmatism. >> The outcome for the right eye is certainly an enormous improvement, >> but I wonder if anything should be done about some issues: [quoted text clipped - 10 lines] > problem is coming from the left eye, unless the above is with that eye > covered up. With left eye covered, I see very blurry at distance with the right eye. Adding a +1 reader to the right eye makes the distance vision worse. The uncorrected left eye is better at distance than the right eye. Right now, my best distance option is no dimestore readers - the brain wants to use the right eye. I know that I'll get an Rx and glasses at my followup to the ophthalmologist next week, and then I'll really get to use both eyes ... I have high hopes for that! >> 2. The two eyes are focused at different distances. I had monovision >> contacts for couple years and they were fine, (I also had [quoted text clipped - 16 lines] > phenomenon called dysphotopsia. It may go away completely, or you may > learn to ignore it. Time will tell That's the question I was really hoping to learn about - does this effect physically go away, or is it one of the kind of things the brain learns to filter, or is it going to persist ... I'm worried it might persist because it result in image changes in the peripheral vision as I look in different directions. So I was really pleased to hear your experience report - that this stopped being an issue for you! >> 4. a point light source off-axis maybe 45deg causes a bright arc of >> light to appear; the center of the arc is diametrically across the [quoted text clipped - 23 lines] > easier before the scarring sets in and tightens it up. Alternatively, > just get some good glasses prescribed and you'll do just fine. If the dark crescent was going to stay and be a lifetime bother, and replacement could help, I'd have it switched for a better distance vision - and now I know to seek to do it soon. (I wish I had pressed my previous doc on the left-eye issues ... sigh ...) But if I can adapt (physically or cognitively) then it's not worth the risks involved; instead, if the antimetropia becomes too annoying for when I'm spectacle-less, then I'll look into the corneal treatment options. Dr Stacy and Dr Robins - many thanks for arming me with enough information (in this response and in your continued efforts on sci.med.vision) to have an effective conversation with my ophthalmologist! Wayne Stidolph > I don't have the Rx - I ought to, but don't. I wear +2.5 to +3 readers > to read with the left eye, and +1 readers to see at far with the left [quoted text clipped - 6 lines] >>> 1. The lens is the wrong power for distance - it is focused at a bit >>> under arm's length. Ok then at least you can, right now, fix your near vision. Take the 2.5 or 3.0 readers and remove the right lens from them. This should give you very good near vision binocularly. It may look wierd, but then so does a monacle... The right eye is my dominant eye, so my distance >>> vision is very blurred (touch for driving, nature viewing and such >>> ... it's blurred enough that I see double at infinity). The doc >>> warned me this could happen, because the cataract and ICL interfered >>> with making a precise axial measurement; so he used the measurement >>> taken by my original ophthalmologist 5 years ago. Likewise, go get a quick refraction and distance Rx made at the local 1 hour optical and see how you do. If it's not acceptable (after a good college try of a day or 2), THEN consider explanting and replacing the left IOL. >I know that I'll get an Rx and glasses at my > followup to the ophthalmologist next week, and then I'll really get to > use both eyes ... I have high hopes for that! If you can wait, fine. I'm too impatient and would be out there right now getting some help. You might be more patient... >>> 2. The two eyes are focused at different distances. I had monovision >>> contacts for couple years and they were fine, Well, you won't get satisfactory monovision with that left eye being hyperopic unless you are willing to wear a contact on it (which would probably give you a decent monovision result). > If the dark crescent was going to stay and be a lifetime bother, and > replacement could help, I'd have it switched for a better distance > vision - and now I know to seek to do it soon. (I wish I had pressed my > previous doc on the left-eye issues ... sigh ...) > But if I can adapt (physically or cognitively) then it's not worth the > risks involved; instead, if the antimetropia becomes too annoying for > when I'm spectacle-less, then I'll look into the corneal treatment options. I'd go by what happens in the 1st 2 to 3 weeks. If the crescent is improving (less bothersome, less noticeable), then you really only have to deal with the refractive problem, which is easily fixable with glasses or contacts... w.stacy, o.d. |
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